Table of Contents IntroductionGather equipmentPreparationNasal tampon insertionInflatable pack insertionFurther management Introduction Wash hands, Introduce self, Patients name, Explain procedure fully and get consentExplain it will be uncomfortable and they may need to cough up blood pushed back down – give them a bowel Gather equipment Equipment list 10% xylocaine spray (or 1% lidocaine in 2-5ml syringe sprayed fast from broken white needle)Pack optionsNasal tampon (7.5cm ideal, also 5cm and 10cm available) e.g. Netcell nasal pack, MerocelInflatable pack (7.5cm ideal, also posterior pack available)  e.g. Rapid RhinoKY jelly10ml syringe (filled with saline if using nasal tampon, or air if using inflatable pack)TapePaper towelsCardboard bowl Preparation Apply gloves and apronSpray anaesthetic into nostril Nasal tampon insertion Ensure nasal tampon has a suture attached at one end (if not, place one)Put KY jelly all over nasal packWith your non-dominant hand, push up on the tip of their noseThen immediately insert the nasal tampon into nostril horizontally in the sagittal plane (see image)Advance horizontally along the floor of the nasal cavity in one motion until maximum depthThe outer tip with suture attached should be next to the tip of the noseSlowly expel the a few mls of saline from the syringe into the nostril to swell up the nasal pack like a tamponTape the string on their cheek Nasal tampon insertion Inflatable pack insertion Remove pack from its sleevePlace in bowel of sterile water (not saline) for 30 secondsWith your non-dominant hand, push up on the tip of their noseThen immediately insert the inflatable pack into nostril horizontally in the sagittal plane (see image)Advance horizontally along the floor of the nasal cavity in one motion until maximum depthThe outer tip with suture attached should be next to the tip of the noseAttach 10ml syringe full of air and inflate until pilot cuff is firm but with some bounce (no set volume)Tape the tubing to their cheek Further management Full history and ABCDE assessmentSecure IV access and send bloods including FBC, G&S, clottingRefer to ENT team for nasal cauterisation